Provider factors and patient-reported healthcare discrimination in the Diabetes Study of California (DISTANCE)

Patient Educ Couns. 2011 Dec;85(3):e216-24. doi: 10.1016/j.pec.2011.04.031. Epub 2011 May 24.


Objective: We examined provider-level factors and reported discrimination in the healthcare setting.

Methods: With data from the Diabetes Study of Northern California (DISTANCE) - a race-stratified survey of diabetes patients in Kaiser Permanente Northern California - we analyzed patient-reported racial/ethnic discrimination from providers. Primary exposures were characteristics of the primary care provider (PCP, who coordinates care in this system), including specialty/type, and patient-provider relationship variables, including racial concordance.

Results: Subjects (n=12,151) included 20% black, 20% Latino, 23% Asian, 30% white, and 6% other patients, with 2-8% reporting discrimination by racial/ethnic group. Patients seeing nurse practitioners as their PCP (OR=0.09; 95% CI: 0.01-0.67) and those rating their provider higher on communication (OR=0.70; 95% CI: 0.66-0.74) were less likely to report discrimination, while those with more visits (OR=1.10; 95% CI: 1.03-1.18) were more likely to report discrimination. Racial concordance was not significant once adjusting for patient race/ethnicity.

Conclusions: Among diverse diabetes patients in managed care, provider type and communication were significantly related to patient-reported discrimination.

Practice implications: Given potential negative impacts on patient satisfaction and treatment decisions, future studies should investigate which interpersonal aspects of the provider-patient relationship reduce patient perceptions of unfair treatment.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • California
  • Diabetes Mellitus / ethnology*
  • Discrimination, Psychological*
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Managed Care Programs / standards
  • Middle Aged
  • Patient Satisfaction
  • Prejudice
  • Primary Health Care / standards
  • Professional-Patient Relations*
  • Quality of Health Care*
  • Racial Groups / psychology
  • Racial Groups / statistics & numerical data*
  • Young Adult